Yokota Hiroyuki, Naoe Yasutaka, Nakabayashi Motoaki, Unemoto Kyoko, Kushimoto Shigeki, Kurokawa Akira, Node Yoji, Yamamoto Yasuhiro
Department of Emergency and Critical Care, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan.
J Neurotrauma. 2002 Sep;19(9):1007-15. doi: 10.1089/089771502760341929.
Thrombomodulin (TM), which is located in the surface of the endothelium in the arteries, veins, and capillaries of major organs such as the brain, lungs, liver, kidneys, skeletal muscles, and gastrointestinal tract, is one of several indicators of endothelial injury. Von Willebrand factor (vWf), which is synthesized by endothelial cells, is also an endothelial specific glycoprotein. The serum level of vWf increases in response to various stimuli without endothelial injury. An elevated serum level of vWf may suggest endothelial activation in severe head injury. We hypothesize that the degree of cerebral endothelial activation or injury depends on the type of head injury and that measuring the TM and vWf is useful for predicting delayed traumatic intracerebral hematoma (DTICH), produced by weakness of the vessel wall, occuring either as a direct or indirect effect of head injury. The values of vWf in focal brain injury (ranging from 332.5 +/- 52.8% to 361.7 +/- 86.2%) were significantly higher than those in diffuse axonal injury from 2 h to 7 days after the injury occurred (ranging from 201.6 +/- 59.5% to 242.5 +/- 51.7%). The serum level of TM in focal brain injury (ranging from 3.84 +/- 1.54 to 4.12 +/- 1.46 U/mL) was higher than that in diffuse axonal injury (ranging from 2.96 +/- 0.63 to 3.67 +/- 1.70 U/mL), but these differences were not statistically significant. In patients with DTICH, TM was significantly higher than in patients without DTICH (p < 0.01). The results of our study demonstrate that the degree of endothelial activation in focal brain injury was significantly higher than in diffuse brain injury. In addition, the serum level of TM in patients with DTICH was significantly higher than in patients without DTICH. These findings suggest that cerebral tissue injury is often accompanied by cerebral endothelial activation, and that these two phenomena should be distinguished from each other. The levels of serum TM and vWf appear to be good indicators of the cerebral endothelial injury and of endothelial activation in severe head injury.
血栓调节蛋白（TM）位于大脑、肺、肝脏、肾脏、骨骼肌和胃肠道等主要器官的动脉、静脉和毛细血管的内皮表面，是内皮损伤的几个指标之一。血管性血友病因子（vWf）由内皮细胞合成，也是一种内皮特异性糖蛋白。在无内皮损伤的情况下，vWf的血清水平会因各种刺激而升高。严重颅脑损伤时血清vWf水平升高可能提示内皮激活。我们假设脑内皮激活或损伤的程度取决于颅脑损伤的类型，并且测量TM和vWf有助于预测因血管壁薄弱导致的迟发性外伤性脑内血肿（DTICH），这是颅脑损伤的直接或间接后果。局灶性脑损伤患者损伤后2小时至7天的vWf值（范围为332.5±52.8%至361.7±86.2%）显著高于弥漫性轴索损伤患者（范围为201.6±59.5%至242.5±51.7%）。局灶性脑损伤患者的血清TM水平（范围为3.84±１.54至4.12±1.46 U/mL）高于弥漫性轴索损伤患者（范围为2.96±0.63至3.67±1.70 U/mL），但这些差异无统计学意义。DTICH患者的TM显著高于无DTICH的患者（p＜0.01）。我们的研究结果表明，局灶性脑损伤的内皮激活程度显著高于弥漫性脑损伤。此外，DTICH患者的血清TM水平显著高于无DTICH的患者。这些发现提示脑组织损伤常伴有脑内皮激活，且这两种现象应相互区分。血清TM和vWf水平似乎是严重颅脑损伤中脑内皮损伤和内皮激活的良好指标。
